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Prepared by: Antistigma Home
Page National Stigma Clearinghouse Web:
<http://community.webtv.net/stigmanet>
E-mail: stigmanet@webtv.net <mailto:stigmanet@webtv.net>
ADVANCE DIRECTIVES Articles about Advance Directives:
1. Mary Ellen Copeland
2. Bruce Taylor Seeman 3. Daniel
Fisher 4.
NAPAS Duke University Program on Psychiatric
Advance Directives (Click here)
<http://pad.duhs.duke.edu/> Advance Directives by
Mary Ellen Copeland Mental Health Recovery Newsletter, May 2004 Through the
past several issues of this newsletter, I have been addressing various parts
of the Wellness Recovery Action Plan. In this issue I want to focus on two
parts of the Advance Directive: signs that I need assistance and support
from others, and a home/community/respite plan. An Advance Directive
is like the living will of mental health. You may have heard it referred to
as a Crisis Plan. There is a form for this plan that you can download on the
website www.mentalhealthrecovery.com. It is also available there in Spanish.
When I mention the Advance Directive, many people say to me, I don't need an
Advance Directive now that I am using the Wellness Recovery Action Plan
(WRAP). In fact, you may be one of the many people who say that since they
started using WRAP, they haven't had a crisis. And that is great. Or they
will say, I haven't had a crisis in years so I don't need an Advance
Directive. I disagree. Given the uncertain circumstances of the world, and
of our lives, we never know when we might get overwhelmed and old difficult
feelings, thoughts and behaviors return. We may become deeply depressed,
very anxious and agitated, begin hallucinating or hearing voices, or begin
to abuse substances that we have avoided for a long time. Without an Advance
Directive, others can take over control of your life. Perhaps people you
don't want to be involved will be making decisions for you. You may be given
treatment that have not helped, or even been harmful in the past. You may be
restrained or coerced in ways that are traumatizing. Having an Advance
Directive keeps you in control even when it feels like things are out of
control. The people you have chosen will take over, and do the things you
want them to do, things that will help you to recover quickly. If you don't
have an Advance Directive, people might take over when you can really use
your WRAP to take care of yourself, they might do things that are not
helpful and they might assist you in ways that are not helpful to you. They
might make the situation worse. You may have developed the first four parts
of WRAP. Those are the parts that you use for yourself. You write it so you
can understand it. The Advance Directive or Crisis Plan is different.
You have to write it so others can understand it, so that they can do for
you whatever it is that would be most helpful to you. When you have
completed your Advance Directive, you give a copy to each of the people you
want to help you. Review it with them in case they have any questions or
there is something they don't understand. You could even have all your
supporters get together and discuss your plan with you to assure that
everyone will do what you want them to do. Some sections of the plan are
quite straightforward and you can easily do these on your own or in your
WRAP group: what you are like when you are well, who you want to assist you
when you are in crisis, the medications you are using, treatments that help
and those that don't. The sections I am going to address here are more
difficult for most people. They were hard for me. Signs that others need
to give me assistance and make decisions for me. It is really important
to take your time developing this section. You don't want people stepping in
and taking over when you can take care of yourself. Think back to times when
you were having the most difficulty and really couldn't think clearly or
take care of your self. This is the worst of it. It is not pleasant. If you
think about it for a while and start feeling badly, leave it for a while and
come back to it later. Even better, work on it with a friend or in a WRAP
book. After you finish, or when you take a break, do some thing special,
something that makes you feel good about your self, like listening to a
favorite CD, calling a good friend, playing with your pet or doing some art
work. When you write these things you want to be very specific so someone
else can understand it. They are different for everyone. Some ideas would
include: -Washing my face so much that it is red and bleeding and I still
won't stop -Counting things- like ceiling tiles-over and over without
stopping for four hours -Shoplifting -Purposefully breaking up furniture
-Being violent with others -Non-stop crying for two days -Thinking I am
someone famous -Spending over $100 on things I clearly don't need- like junk
from the dollar store -Thinking the television is talking to me -Wearing
lots of garish make-up -Hitting my pets or children -Not knowing who my
family members and friends are -Not moving for three hours -Refusing to eat
for more than two days -Consuming alcohol -Having other signs that I am not
OK and telling others I am fine Home/Community/Respite Plan Even
though you may be having a very difficult time, hospitalization may not be
the best option. For me, if I stay at home with my things, sleep in my own
bed, have my own food while I am supported by close friends and family
members who know what to do that is helpful, I get past the difficult time
more quickly. Hospitalization in a place where you have never been before,
where you are away from your friends and family as well as many of your
wellness tools, may not help and may make you feel worse. In addition,
because of insurance issues, hospital stays are often very short, too quick
to be really helpful, and are sometimes not even an option. Many people have
benefited from developing a plan so that they can stay at home supported by
friends and family members, possibly attend a treatment program during the
day, or a peer run crisis respite center. This is a much better option for
them. For instance, a number of years ago, I wrote such a plan for myself.
And a time did come when I was deeply depressed. I didn't tell anybody. And
I was living alone at the time. However, my counselor and my daughter
noticed the signs that I had written in my plan. As they had been
instructed, one of them called all the women in my women's group and several
family members I had named in the plan. They arranged so that someone would
be with me around the clock. Mostly they had two-hour shifts, but one person
spent the night each night. They knew what food would be most appealing to
me so they cooked it for me. They knew what kind of activities to encourage
(like walks) and what not to encourage (playing board games or watching the
news on television). They knew who my care providers were, were in touch
with them, made arrangements to take me to see them, and actually took me
there. When I was rude and told them to leave, they didn't pay any
attention. My plan also told them that if I became abusive to them or they
felt they could not keep me safe, who they should contact and what should be
done. It worked. In a few days I was feeling much better and could begin the
process of recovering from this crisis. My more recent plan contains several
crisis respite centers as options. I haven't had to use it recently, but if
I had to, I have already made those arrangements. There are also several
programs in the community that I could attend during the day that might be
helpful and that would give my supporters a break. When you are thinking
about this plan for yourself, thinking about answers to the following
questions might be helpful. You could discuss them in your WRAP group: -Is
hospitalization always an option when you are having a hard time? -Is
hospitalization the best option when you are having a hard time? -What are
the pros and cons of hospitalization? (Advantages of staying home rather
than going to the hospital when you are having a difficult time). -Why is it
important to have a plan so that you could stay at home or in the community?
-Why might you feel better more quickly if you stayed at home or in the
community? -What would you need in order to stay home when you are having a
difficult time? -What could you do for yourself if you stayed home when you
were having a difficult time? What are the Wellness Tools you could use?
-What could others do for you if you stayed home when you were having a
difficult time? -Do you have friends or family members who could take turns
providing you with care and support? Who are they? -Are there any programs
in your community that you could attend during the day and be at home in the
evening? What are they? -Are there any respite programs in your community?
What are they? -What health care providers would be available to support you
and how could they help? Wellness Tool - Getting Through These Difficult
Times This is a very hard time in the world. Every time we read the
newspaper or watch television, we see pictures of terrible things that are
happening. This can be very upsetting. Some people are noticing that they
are feeling more depressed and anxious. Difficulty feelings are coming up
more often. Several things you might do that would help: -Decide if there is
some action you could take based on your beliefs and concerns. It might be
an e- mail, letter or phone call to a public official, sending a letter to
the editor of your newspaper, attending a public meeting, taking part in a
vigil or demonstration or sharing your concerns with others. -Avoid reading
the newspaper or parts of the newspaper that are disturbing, be selective
about what you watch on television and listen to on the radio. -Do lots of
good things for yourself that affirm the wonderful person you are-take a
walk, visit a friend, make yourself something special to eat, play with a
child or grandchild -- whatever it is that makes you feel good. -Do
something nice for someone else. Bake a loaf of bread for a neighbor. Help
them with household chores. Visit someone who is sick. -Use your Wellness
Recovery Action Plan. Do the things on your Daily Maintenance Plan every
day. It is especially important now when you are under constant stress. Use
the other parts of your plan as you need to. Check your list of Wellness
Tools. Are there any other good things you could be doing for yourself?
Source: NYAPRS E-News |
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ARTICLE 2 Psychiatric Documents Can Aid Mentally Ill in Crises BY
BRUCE TAYLOR SEEMAN Newhouse News Service, May 2004 People with
psychiatric problems who struggle daily to maintain their footing are
relying on an increasingly popular document to protect them if they falter:
a page or two of written instructions that spell out their care. Some
documents list medications to be given. Others identify which doctor to
call, whether electric shock therapy may be used, or what kind of music
works best to soothe a patient's distress. The documents, called
"psychiatric advance directives" (PADs), are similar to living wills: Both
aim to honor people's autonomy by carrying their voices forward if they
become too sick to speak for themselves. No national estimate exists on how
many people have chosen the tool, and doubts persist among skeptics who see
risks in giving patients a forceful voice regarding their treatment in
psychiatric emergencies. But people like Kathy Cleary, 44, a former nurse
diagnosed with borderline personality disorder and depression, say a greater
voice in treatment is precisely why the documents make sense. During a
difficult episode, Cleary used her PAD to block an attempt by jittery
hospital workers to put her in leather restraints. Such a step would only
have escalated her agitation, she says. "I was arguing with them," remembers
Cleary, of East Hartford, Conn. "I had the document in my hands. They said,
`We´ve never heard of this.´ They said they wanted to call their lawyer. And
their lawyer said, `We´re not sure this is perfectly legal, but until we
find out differently, we better do as it says."´ About 9 million Americans
struggle with serious mental illnesses such as bipolar disorder,
schizophrenia or clinical depression. Many experience repeated episodes of
instability. When healthy, however, most are competent to outline their
desired care, especially with professional help, mental health advocates
say. Some of the documents are written under state laws on living wills that
allow people to formalize choices for end-of-life medical care. Some states
-- Ohio recently became the 19th -- have enacted laws that specifically
outline procedures for establishing an advance directive for mental health
care. The first large-scale study of PADs is under way with a $2 million
grant from the National Institute of Mental Health. Led by a team of Duke
University researchers, the four-year project will follow 500 people to see
whether providing help motivates people to complete PADs, and how well the
documents work with doctors and hospitals. Mary Ellen Mixon, 56, would like
to establish a PAD that outlines important features of her illness. She is
claustrophobic. She needs her medication at 7 each night. At times, her mind
races. Given her struggles with bipolar disorder, the former bank executive
knows she needs help completing the document. "My lack of control is my
fear," says Mixon, of South Pasadena, Fla. "I've always made my own
decisions, on my career, my kids." Now, she says, she worries that a bad
turn will send her into the streets, or to an unfamiliar psychiatric
hospital, where "they don't know me." Jeffrey Swanson, the associate
psychiatry professor at Duke who is leading the new study, said an effective
PAD may act as a "psychiatric resume" for a patient in crisis: "This is who
I am. I had my first psychotic episode when I was 21 years old. This is the
medication I am allergic to. This is the one that works best for me. And I
want you to notify my mom." Like a living will, a PAD requires two witnesses
and must be notarized. It may also identify someone who accepts the legal
responsibility of acting as an advocate when the document's author is deemed
incompetent. In Connecticut, state officials are finalizing a PAD "tool
kit," a 20-page guide to help consumers complete their documents. One of the
promoters of the project is Karen Kangas, director of recovery affairs for
the state mental health department. Kangas, diagnosed with bipolar disorder,
has completed a PAD that outlines preferred medication and other treatment
particulars. Her representative is her son, Deron Drumm, 32, who as a child
watched her ride the cruel ups and downs of her disease. He once called 911
just in time to prevent her death from an overdose. And he has listened to
his mother's painful stories about her treatment once inside the locked
halls of psychiatric hospitals. "I envision a doctor not wanting to
recognize (her PAD)," says Drumm. "But I've got power of attorney, and I
have the advance directive. If he insists on a medication that I know
doesn't work, I'm ready to fight him. I know how to do it." While many
doctors and hospitals are accustomed to living wills being used as guides
when patients approach death, PADs may be used in more complicated
circumstances. People caught in a psychiatric crisis may disavow earlier
written requests for hospitalization or medication. They could become
combative, forcing doctors to consider whether the no-restraints or
no-isolation declarations in their PADs should be overruled for safety's
sake. In a recent medical journal study, a University of Washington
researcher found that nurses, social workers, doctors and hospital
administrators had concerns about the documents. Some professionals said
people with psychiatric illnesses might not be competent to outline their
own care. Others worried that doctors would not have access to the documents
or even know that a patient had one. Some said psychiatric advance
directives would spawn legal suits by those claiming the documents were not
properly honored. Dr. Paul S. Appelbaum, chairman of the psychiatry
department at the University of Massachusetts, said PADs have "considerable
potential" but could become outdated and dictate treatment for a patient
whose condition is evolving. "These issues really need to be thought
through," said Appelbaum. Advocates for people with mental illness,
meanwhile, say much of the skepticism can be attributed to the documents'
newness. They insist that until a person with psychiatric disabilities is
judged incompetent, he or she carries the same rights as others to decide
about care. "They have this idea that consumers can't rationally decide
about their own advance directives," said Chris Koyanagi, policy director
for the Bazelon Center for Mental Health Law, a legal advocacy group based
in Washington, D.C. Swanson, the Duke researcher, said the documents may
help patients even if an emergency never arises. People who talk to a doctor
about their treatment preferences, as well as what may be done to prevent a
relapse, may feel more in control of their care and adhere to that
treatment. "If someone starts to get sick and loses insight into needing
treatment, the therapist may say, `Let´s see what you said (in your PAD)
about needing treatment to avoid going back to the hospital," Swanson said.
Mental health organizations have posted blank PAD forms on their Web sites.
Some state governments have allotted money for programs that urge people to
sit down with their doctors and complete PADs. Over the past three years, at
least 200 people in Ohio have completed PADs, officials estimated. Mental
health advocates are now exploring ways to establish a privacy-protected
central registry so that doctors, nurses and other professionals can check
to see whether a new patient has a PAD. "This is just another step in the
whole progression of how we deal with mental illness," said Ron J. Rees,
director of the Washington County (Ohio) Mental Health and Addiction
Recovery Board. Meanwhile, a track record is developing among patients who
have successfully used their PADs. Joe Peterson, 51, of New London, Conn.,
was hospitalized in 2000 when doctors tried to force him to take a
schizophrenia drug that he said overmedicated him. Peterson refused, knowing
he had completed a PAD saying he did better on anti-anxiety drugs. "Chemical
restraints such as neuroleptics may not be used," read his PAD. The hospital
initially balked at Peterson's request, then relented and discharged him,
recalled Susan Werboff, director of Connecticut's Protection and Advocacy
for Individuals with Mental Illness Program. Source: Newhouse News
Service |
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ARTICLE 3 Making
Advance Directives Work For You By Daniel Fisher, M.D., Ph.D, Dec. 2000
National Empowerment Center
<http://www.power2u.org/selfhep/directives_work.html>
Typically many of us have had the experience of being forcibly medicated,
restrained, and/or hospitalized during a time of crisis. If only we could
have informed the mental health workers ahead of time of ways that had
helped us get through a crisis in the past, these uses of involuntary
procedures might have been reduced or eliminated. A well-executed Advance
Directive could be such a means of lessening the use of coercive practices.
A poorly executed one, however, could actually increase the use of coercion.
There are a number of challenges to meet to ensure that an Advance Directive
is a friend and not a foe: I. Learn the terminology: 1. Advance
Directive (AD)-a legal document that allows competent people to give
instructions regarding the health care they would like to receive during a
time of crisis when they would not be competent to make their own decisions.
The written part of an AD is called an instructional directive. The AD also
describes the conditions that must occur for the AD to be implemented. The
AD can also designate someone to be your health care agent in the event you
are no longer competent. This is called Durable Power of Attorney (DPOA). A
special case of an AD, which describes the conditions in which life supports
would or would not be provided to an incompetent person, is called a Living
Will. 2. Principal-the person who states his or her health care decisions in
the AD. 3. Health care agent/proxy/attorney-in-fact-some of the names given
to the person designated by the principal to ensure that his or her
instructions in the AD are carried out when the principal is incompetent.
II. Learn about the laws upon which Advance Directives are based: 1. The
Federal Patient Self-Determination Act of 1990 requires that each health
care provider receiving Medicaid or Medicare must: Inform patients of their
state's laws regarding Advance Directives, Note in the patient's chart
whether or not he/she has executed an Advance Directive, Ensure that the
state's Advance Directive laws are followed 2. Learn about your state's
Advance Directive law. Contact your state Protection and Advocacy Agency.
The NEC can give you contact information. III. How to develop a plan
to make an Advance Directive work for you. Advance Directives can benefit a
few consumer/survivors who are good self-advocates and are part of an
empowered social network. On the other hand many consumer/survivors, who
often lack the individual advocacy skills and/or lack strong advocates as
friends, should develop a plan to address the following issues: 1. Make sure
the AD is your plan. Mental health facilities are typically poor at ensuring
that the goals of consumer/survivors are expressed in their treatment plans.
Therefore, an AD prepared by a mental health facility "for" a
consumer/survivor may well not express that person's wishes, but instead
will likely reflect what the provider thinks the person "needs." You should
not sign an AD prepared for you by someone else unless it actually reflects
your wishes. You do not have to sign an AD if you don't like what it says.
You can always prepare your own AD instead. 2. Find a way to ensure that
your doctors will follow the AD. I learned that in Oregon, even though
doctors were given legal immunity, they say they do not have to follow AD's.
In addition, they say that they are not obligated to follow the health care
agent's decisions. There is a case in Vermont testing this last point (see
accompanying article by Xenia Williams). 3. Select a good health care agent.
This needs to be a remarkable person with some of the following traits:
Someone you trust deeply, who cares about your welfare, and who knows you
well Someone who knows your wishes regarding physical and mental health care
through discussions and through access to your instructional directive
Someone who is easily reachable night or day (for instance someone with a
phone or better yet a beeper) and who is willing and able to speak with
health care personnel Someone who is a strong, articulate advocate and is
well informed about the types of treatments proposed Someone who the health
care providers will take seriously Someone whose role will be undisputed.
Some states prevent certain people from becoming agents. For example the
state of Washington excludes your treating provider, and the operators of
certain care facilities. These provisions help prevent conflicts of
interest. 4. Make the AD accessible. Ensure that a person's updated AD is at
the right place at the right time in a manner that recognizes the
principal's need for confidentiality. In urban areas, where someone could be
taken to any number of emergency facilities, this is a big barrier. 5.
Carefully specify when, how, and by whom the principal is declared
incompetent. The threshold could be set at a lower level than the state law
for commitment (such as a person prone to mania might put in an AD that an
agent would take over when they had spent $2,000 beyond his or her means).
6. Clarify the issue of when or if a principal who has been declared
incompetent can revoke the AD. If it turns out that either your wishes are
not being followed or your agent is not working on your behalf, you should
be able to revoke the AD even after you have been deemed incompetent. Some
states do not allow this provision. 7. Develop safeguards to ensure that ADs
are followed in the manner that the consumer/survivor intended. Only a
carefully chosen, highly regarded agent can partly ensure the process is
fair. However, if the status of the agent were low relative to that of the
treating facility, he or she would need outside quality assurance to protect
the rights of the consumer. Such assurances rarely occur in mental health.
These are but a few of the complexities involved in Advance Directives. The
Bazelon Center is urging Protection and Advocacy programs to institute ADs
on a wide scale. Robert Fleischner from the Center for Public
Representation, Northampton, Massachusetts, has prepared an excellent
analysis of ADs: "An Analysis of Advance Directives Statues and their
Application to Mental Health Care and Treatment." A copy can be obtained
from NAPAS, 900 Second St., NE, Washington, DC 20002. Fleischner concludes:
"Despite the uncertainties, their inherent limitations and barriers to their
use, advance directives may offer people with mental illness a formidable
device to gain more control of their treatment and to promote their
autonomy." Several consumer/survivor groups have also indicated an interest
in using them. I would recommend caution and careful study. Some
consumer/survivors have the skills and network needed to have the AD work
for them. Many mental health consumers, however, typically lack many of the
resources, social supports, and self-esteem needed to make an AD work in
their behalf. In such a situation, they are often at the mercy of the system
and there are not sufficient safeguards to ensure that the AD will work for
them. In those cases the AD can actually make it easier for health care
officials to coerce the consumer. We want to find out what people's
experience with advance directives has been. We would love to hear from you.
End of Article by Daniel Fisher ______________________ |
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ARTICLE 4 Q & A re
Psychiatric Advance Directives: A Tool for Taking Control of Personal
Treatment Decisions During a Mental Health Crisis Source: National
Association of Protection and Advocacy Systems, Inc. (NAPAS) February 2000
Many states have recently passed laws which give people the right to
specify, in advance, choices about how they will be treated in the event
that a mental illness renders them incapable of making their own medical
treatment decisions. These "psychiatric advance directive" laws offer an
exciting tool for people with serious mental illness to retain control over
personal choices at the very moment when the structure of the mental health
system threatens a total loss of individual control. What is An Advance
Directive? An advance directive is state statutory authority for a
person to specify, in advance, choices about how he wants to be treated in
the event that illness renders him incapable of exercising treatment
choices. Today, every state has some form of advance directive statute.
There are two types of advance directives: 1)Durable Power Of Attorney
(a.k.a. Proxy or Agent) This is, by far, the most common form of advance
directive. It allows a person to designate agents to make health care
decisions on their behalf if they are unable to do so. This agent is
responsible for carrying out that person's wishes. The wishes could be
described in either a written record of consumer preferences or made known
to the agent in some other way. This person does not need to be an attorney;
2) Instruction Directive A legal document that spells out a person's wishes
regarding their health care in the event that illness renders them incapable
of exercising treatment choices. Most advance directives statutes allow
individuals to make decisions related to mental health (psychiatric)
treatment as well as physical health treatment purposes. This said, it is
not uncommon for an advance directive statute, while allowing mental health
treatment to be addressed, to specifically prevent, the agent from making
certain mental health treatment decisions - usually convulsive treatment,
involuntary commitment and pycho-surgury. A very small number of states
specifically exclude mental health (psychiatric) health care from their
generic advance directives statutes. Most of the states which exclude mental
health (psychiatric) treatment from their generic advance directives statute
have other specific laws which address advance planning for mental health
care. What Are Some Benefits and Barriers to Use of Advance Directives?
Individuals with serious mental illness may find several benefits from
completing an advance directive for mental health care decisions. The
overarching benefit is the opportunity to empower themselves at a time when
mental health professionals determine them incompetent to make medical
treatment decisions. If decision making power is returned, and an individual
is confident the advance directive will be followed, some persons with
mental illness indicated an increased willingness to agree to voluntary
intensive psychiatric care. Advance directives may also improve the quality
of health care received by people with mental illness because it can
identify for mental health providers the types of medical intervention which
have been most beneficial when past crisis situations have arisen. An
advance directive may also improve the quality of care because it offers a
vehicle for sharing information that would normally be unavailable to
personnel. One benefit of improved care is that an individual may be less
likely to need hospitalization or, if hospitalization is necessary, the rate
of stay may be reduced. A fiscal and administrative benefit results from the
existence of an advance directive because it shortens the time spent
litigating issues related to civil commitment and forced treatment. Advance
directives can be a real tool for empowering individuals with mental
illness. However, in some states the advance directive statute itself sets
up barriers to effective use. Some barriers could include a state statute
that: 1) limits the type of treatment that can covered in an advance
directive; 2) fails to make it clear whether the advance directive can cover
psychiatric health care concerns; and 3) have confidentiality restrictions
that limit the information proxies can receive related to diagnosis,
treatment modalities, medications, side effects or community resources.
There are also social and attitudinal barriers that can reduce the effective
use of an advance directive, these could include: 1) health care providers
who refuse to honor advance directives and no penalty for such a refusal; 2)
lack of knowledge by medical or law enforcement personnel about the
existence of an advance directive; 3) receipt of care in an emergency room
or law enforcement setting where there is lack of knowledge of the directive
and little time for consultation with a proxy; 4) a medical and judicial
system which is unsure of the legal weight of an advance directive; 5)
doctors fear the advance directive might direct nontraditional,
inappropriate or expensive care; 6) people with mental illness may not be
able to identify someone they can trust to be their proxy; and 7) mental
health professionals fear civil or criminal liability if they honor an
advance directive over a families objections. What Should a Psychiatric
Advance Directive Include? Every state requires some degree of formality
in the execution of an advance directive. In many states there is a
mandatory form which must be used for the document to be valid. Examples of
some of the issues which could be covered in an advance directive include:
1) specific treatments that have and have not worked in the past; 2) who
should be contacted if an involuntary treatment occurs and preferences for
where that commitment should be; 3) temporary custody arrangements for child
or pet care; and 4) allergies to food and medicines. Where Can I Go for
More Information About Advance Directives? The Bazelon Center for Mental
Health Law (<http://www.bazelon.org>)
has available a sample psychiatric advance directive form which provides
step-by-step guidance for completing an advance directive and raises
personal and legal questions an individual might consider when completing an
advance directive. This document is available on their website or by
contacting their office at: 1101 15th Street, NW, Suite 1212, Washington,
D.C. 20005, (202) 467-5730. In addition, each state has a protection and
advocacy program (P&A) that may be able to provide free guidance and
assistance to individuals who wish to complete an advance directive. For
information about the P&A in your state contact the National Association of
Protection and Advocacy Systems at 900 2nd Street, NE., Suite 211,
Washington, D.C. 20002, (202) 408-9514 or visit their website at
<http://www.napas.org>.
(Disability Issue Areas). This Association also has available "An Analysis
of Advance Directives Statutes and Their Application to Mental Health Care
And Treetment." End of Article _____________________ The Antistigma Home
Page thanks 'Mental Health E-News' a service of the New York Ass'n of
Psychiatric Rehabilitation Services, for forwarding the articles above.
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